Provider Reference Guide (PDF). Box 22 Resubmission and/or Original Reference Number Follow the instructions from the National Uniform Coding Committee (NUCC) billing requirements: For more information, please refer to the1500 Claim Form Reference Instruction Manual, which is available by selecting1500 Instructionsfrom the 1500 Claim Form tab on theNUCC website. If a claim was originally submitted under the wrong NPI or member ID, you must submit a void request for the original claim number. Our address Reach us by mail at: AmeriHealth Caritas Pennsylvania Community HealthChoices200 Stevens DrivePhiladelphia, PA 19113 Participants Please enable scripts and reload this page. AmeriHealth Caritas VIP Care Provider Phone Number: (800) 521-6007: 365 Days from the DOS: AmeriHealth Caritas VIP Care Plus (Michigan) Provider Phone Number, Claims address, Payer ID and Timely filing Limit: 77013: PO Box 853914 Richardson, TX 75085-3914: AmeriHealth Caritas VIP Care Plus Provider Phone Number: (888) 667-0318: 365 Days from the DOS Forgot Member Password For more information about electronic claim submission guidelines, refer to the appropriateHIPAA Transaction Standard Companion Guidefor AmeriHealth New Jersey or AmeriHealth Pennsylvania, available on theTrading Partner Business Center. Learn More. AmeriHealth Caritas District of Columbia, your benefits or how to join. Billing & Reimbursement ;PEAR portal, Claim investigation and corrected claim submission procedures. Medical foster care (MFC) parents can use the Medical Foster Care Parent Quick Reference Guide (PDF) for contracting and claim submission information. A common billing error is to resubmit an original claim type rather than following the corrected claim submission instructions below. To learn about coverage for telemedicine services, please read this Click on the Hurricane banner at the top of the page for more information. This article was revised on October26, 2021, to update the contact information for claim investigations. Provider Contact Information Contact your practice management/hospital information system for instructions on how to receive ERAs from AmeriHealth Caritas New Hampshire under Payer ID 87716 and the ECHO Health, Inc. Payer ID 58379. Call us at 888-YOUR-AH1 (888-968-7241) (TTY: 711). Provider Services: 1-888-922-0007 Provider Network Management: 1-877-588-2248 Credentialing: 1-888-913-0349 Important information: Provider Reference Guide (PDF) Behavioral health provider reference guide (PDF) Provider resources Provider newsletters and updates Claims and billing Training and education Report fraud, waste, or abuse An 837 professional claim transaction is not an appropriate response to a payer's request for additional information. AmeriHealth Administrators. Go to NaviNet, our secure provider portal. Information for AmeriHealth Caritas Louisiana Providers. District of Columbia Medicaid Fee Schedule. 1-833-704-1177 (TTY 1-855-534-6730) Tel: 1-800-984-5933. sales@ahatpa.com. If a copayment was not collected at the time of service, claims will be processed to remove the member liability during adjudication. Electronic claim submissions to AmeriHealth Caritas North Carolina will follow the same process as other electronic commercial submissions. Provider directory. We're looking for talented people to assist us in our mission to help people get care, stay well, and to build healthy communities . Paper claims submission. No additional payment will be made to the provider. Box 7307 London, KY40742. It looks like your browser does not have JavaScript enabled. You can renew your coverage by going to https://districtdirect.dc.gov or calling the Economic Security Administration (ESA) at 202-727-5355 (Language and Translation Line: 1-855-532-5465). Learn how to submit claims to AmeriHealth, use EDI services, and access helpful user guides on claims submission and provider appeals and disputes. Please note that on weekends and holidays from February 15 through September 30, your call may be sent to voicemail. Please enable scripts and reload this page. Coordinated access to claims services, medical management, and provider networks. If other cost-sharing (i.e., coinsurance, deductible) was not collected at the time of service, the claim will be processed to remove the cost-sharing member liability during adjudication. By mail: AmeriHealth Medigap Plans Medicare Department P.O. AmeriHealth Caritas North Carolina Member Services Line. - Fri., 8 a.m. - 5 p.m. 1-800-275-2583: Office Administration/Patient Education Resources Order Form To contact AmeriHealth Administrators 1-800-492-2385 Claims 1-800-841-5328 www.pearprovider.com AmeriHealth HMO/POS (NJ) Q1C,Q1P, 65 (NJ) 2 AmeriHealth . . Phone: Call 1-833-870-5500 (TTY 1-833-870-5588), 7 a.m. to 5 p.m., Monday through Saturday. COVID-19 (Coronavirus): Member cost-share claims processing for PCP telemedicine services for AmeriHealth Pennsylvania members, This article was revised on October26, 2021, to update the contact information for claim investigations. AmeriHealth Caritas Florida. Corporate Communications Phone: 1-215-863-5458. For PPO members with AmeriHealth Caritas Delaware Claims can be submitted electronically through Change Healthcare, or via another clearinghouse. Check this page regularly for updated provider materials and communications. If you need to edit any data field on a claim, a corrected claim must be submitted with the new information, and you need to note the original claim number on the corrected claim. We ask that providers wait until after the claim has been processed, and adjusted, to bill the member for any applicable cost-share noted on the Provider Explanation of Benefits. replacement of prior claim (correction of the charges/services/diagnosis/modifier originally submitted by the provider); void/cancellation of prior claim (reflecting the elimination of a previous claim in its entirety); addition of late charges to an institutional claim after the original claim was processed. Box 21545 Eagan, MN 55121 AmeriHealth Administrators Not applicable 54763 54763 . Phone: 1-267-298-2490 Email: pjakuc@amerihealthcaritas.com For human resource and job-related inquiries: Email: humanresources@amerihealthcaritas.com Corporate mailing address and main phone number: AmeriHealth Caritas Corporate Office 3875 West Chester Pike Newtown Square, PA 19073 Phone: 1-215-937-8000 For media-related inquiries: Use SHIFT+ENTER to open the menu (new window). You can enroll online, over the phone, by mail or by using the mobile app. 202-842-2810 or 1-866-842-2810. Member Services (MMA) 1-855-355-9800 (TTY 1-855-358-5856) Provider Services 1-800-617-5727. Wellness programs. Take care with coronavirus. If you are dissatisfied with a service not concerning medical necessity, mail us at: AmeriHealth Caritas PA CHC Informal Provider Disputes P.O. Medicaid Contact Center. Provider disputes. New user? Member Services also has free language interpreter services available for non-English speakers. . Request information about our individual and group plans. Find out more about the coronavirus and how you can help prevent it. Clinical information is required to process claims that include pre-existing conditions and issues pertaining to mental health, psychiatric and . This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of AmeriHealth, AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey. Contact us by phone. In support of the process for PCP, specialist, and behavioral health visits, we ask that providers If a copayment was not collected at the time of service, the claim will be adjusted to pay the provider the copayment amount. Box 7387 London, KY 40742-7387 Check claim status Go to NaviNet or call Provider Services at 18885991479 . Box 7110 London, KY 40742-7110. Keep this sheet of contact information close by for when you need to give us a call. If you have questions, you can call AmeriHealth Caritas Delaware Provider Services at 1-855-707-5818. For more information, contact the plan or read the AmeriHealth Caritas VIP Care Plus Member Handbook. If you have questions regarding your individual benefits or claims status, please call the Member Services telephone number on the back of your ID card. This article was updated on June 6, 2022, to add PEAR PM information.. Initial claims: 180 days from date of service. 1-833-704-1177 (TTY 1-855-534-6730) Calls to this number are toll-free. 1-888-643-0005 : Check claims status Need assistance reporting a claim? Telemedicine claims. For information regarding AmeriHealth Caritas Pennsylvania in South Central and Northeast Pennsylvania: Mailing address. AmeriHealth New Jersey may require the submission of clinical information before or after the processing of a claim for services rendered to members. A notes field is available in the Remarks section of the 1500 Claim Submission Header to provide a detailed description. 24/7 Nurse Line. View the claims payment schedule A health care plan that is easy to use and understand. Any corrected claim submissions to remove the J3490 code will require another adjustment to the corrected claim to reimburse for the copayment or other cost-sharing. AmeriHealth New Jersey may require the submission of clinical information before or after the processing of a claim for services rendered to members. [email protected] https://www.ahatpa.com/html/contact-us/index.html . Exclusive National Lab Provider (NJ Only), 1500 Claim Submission transaction on PEAR PM. If you need these services, contact AmeriHealth Caritas Delaware 24 hours a day, seven days a week, at: Diamond State Health Plan: 1-844-211-0966 (TTY 1-855-349-6281). To initiate the electronic claims submission process or to get more information, contact Change Healthcare at 877-363-3666. 1-833-712-2262 (TTY 1-866-209-6421) Available 24 hours a day, seven days a week. You may be trying to access this site from a secured browser on the server. Claims requiring submission of clinical information. When submitting a claim, enter the appropriate Frequency Code in the fourth position of the Type of Bill: Field location 64 Document Control Number. Philadelphia, PA 19103. Field location 4 Type of Bill Frequency Code. Claims will be denied if ordering, referring, or prescribing provider is . AmeriHealth Caritas North Carolina Attn: Claims Processing Department P.O. When using Claim Frequency Type Code 7 (Replacement of prior claim) or 8 (Void/cancellation of prior claim), the provider must complete the Original Claim Number field. 1-855-375-8811 (TTY 1-866-209-6421) Available 24 hours a day, seven days a week. Reach clinical pharmacy services, program support, and customer support. AmeriHealth New Jersey will contact you if clinical information is required for claims processing. Box 7412 London, KY 40742-7412 Check the status of a claim To check your claim status, sign in to NaviNet and select Claims Status Summary under Administrative Reports. For more information about telemedicine services, please refer to Medical Policy (TTY/TDD 202-216-9885 or 1-800-570-1190) AmeriHealth Administrators. Medical and Claim Payment Policy Portal.. You must submit a new claim through one of the following methods: Proper submission instructions for each method are detailed below. Loop ID: 2300, Reference: CLM05-3 (Claim Frequency Type Code); If CLM05-3 contains 5 (Late Charge(s) institutional only), 7, or 8, prior claim information is required. Call 1-800-297-2726. The AmeriHealth Caritas Florida Payer ID # is 77003. Additional questions from providers may be directed to the Florida Medicaid Contact Center at 1-877-254-1055. These previous claims did not have claim numbers assigned nor was a final Provider Explanation of Benefits (professional) or Provider Remittance (facility) produced. AmeriHealth Casualty Services is a full-service workers' compensation third-party administrator (TPA), providing services in Pennsylvania, New Jersey, and Delaware. customerservice@ahatpa.com FutureScripts Call 1-888-678-7013 1-888-671-5285 (fax) iEXCHANGE 1-888-444-4617 For behavioral health services, please call the phone number listed on the patient's AmeriHealth Administrators ID card. Explanation of Benefit (EOB) codes (PDF) Small business health insurance. How to Contact AmeriHealth Medigap Prospective members By phone: Call 1-866-365-5345 (TTY/TDD: 711) toll-free, 8 a.m. to 8 p.m., seven days a week. -SX075 54704 837I - 12X28 Paper Claims Address AmeriHealth Administrators P.O. View our Member benefits. Login to AHClaims To help us direct your request, please select one of the following. Box 7367 London, KY 40742 We're AmeriHealth Caritas, a health care company that takes pride in caring for America's most vulnerable people. article. Want to check the claim status of a service? Provider claims and billing manual (PDF) Submitting a claim. Call our provider center at 1-833-644-6001. Your feedback, questions, and concerns are always welcome. AmeriHealth Caritas North Carolina Behavioral Health Crisis Line. Provider Services (direct all inquiries or issues) directly to AmeriHealth Administrators) 1-800-841-5328. Claims and Billing Information. AmeriHealth Caritas Florida operates as a Medicaid managed care plan through Florida's Statewide Medicaid Managed Care (SMMC) program. Facility Payer ID Provider Number Reference, Professional Payer ID Provider Number Reference, Request to Update Procedure Code(s) on an Existing Authorization, Appeals for procedures denied as possibly cosmetic, Appeals of claims disputing multiple-procedure payment reduction, Appeals of claims requesting additional reimbursement for an unusual surgical procedure, Appeals of claims requesting reimbursement in pre-op or post-op period, Appeals of claims for experimental or investigative services, Appeals of claims for pre-existing conditions, Appeals of claims disputing claim coding edits, Audit/investigation requests from our Corporate and Financial Investigations Department, Behavioral health claims for which required authorization was not obtained, Behavioral health emergency room services more than $500, Claims for procedures that are possibly cosmetic, Claims submitted with procedure codes that are unlisted or not otherwise classified, Claims that require a review for possible pre-existing conditions, Emergency room claims submitted with a nonemergent diagnosis, Inpatient and outpatient post-service authorization requests. Through dedicated providers like you, we serve New Hampshire Medicaid members in the Medicaid Care Management (MCM) program. It was posted as a Notification on April 2, 2020, and wentinto effect July 1, 2021. AmeriHealth Caritas Pennsylvania Provider Appeals Department P.O. Net new claims will need to be submitted with the updated data resolving the reason for rejection. Contact your Account Executive. Box 7110 London, KY 40742-7110. Billing information. Learn how AmeriHealth New Jersey meets the vast needs of a company with 50 or more employees. . Customer service hours are Monday - Friday, 8 a.m. - 6 p.m. Extended evening and weekend hours may vary. Call Provider Services at 1-800-617-5727 to speak to a representative. . If cost-sharing was applied to the claim and it should have been removed, the claim will be adjusted* to pay the provider the correct amount. AmeriHealth Caritas Next Attn: Claims Processing Department P.O. Contact us for technical support. AmeriHealth is committed to providing our members with access to the care they need during the COVID-19 pandemic. Please turn on JavaScript and try again. The move is strategically planned so that there is limited disruption to service. This article was updated on June 6, 2022, to add PEAR PM information. was collected at the time of service, we will process and mail an administrative check to the member for the amount paid. Contact Provider Account Executives Account Executive Territories (PDF) Contact an ancillary account executive (PDF) Contact a hospital account executive (PDF) AmeriHealth Caritas Louisiana can accept claim submissions via paper or electronically (EDI). CARE IS doing the most you can to help people. Working with you, we aim to deliver excellent care and improved health outcomes to our members. Keep your member contact information up to date. If more than one original claim type is received for the same encounter, it may be denied as a duplicate with reference to rebill as a corrected instead of an original claim submission. Main Line 1-855-464-8812 Providers interested in joining the AmeriHealth Caritas Florida network should call this number. Phone number. For HMO/POS members, the following will occur based on the scenario: If a copayment Forgot Member Username All claims sent to AmeriHealth Caritas Ohio, through the central PNM portal, should include the AmeriHealth Caritas Ohio Payer ID in 1000B Receiver Loop and 2010BB Payer Name Loop. If you have additional questions, please contact our Provider eBusiness team through our online Provider eBusiness Inquiry form for AmeriHealth New Jersey and . This will ensure the provider will be made whole financially. Clinical information is required to process claims that include pre-existing conditions and issues pertaining to mental health, psychiatric and substance abuse, organ transplants, cosmetic and reconstructive surgery, and/or a number of other limited categories. As a result of the processes we have implemented, you will not need to contact the call center or submit a claim investigation viaPEAR Practice Management on the Provider Engagement, Analytics & Reporting (PEAR) portal to request an adjustment. Billing and Claims. Register here. AmeriHealth Caritas Pennsylvania 8040 Carlson Road Suite 500 Harrisburg, PA 17112 Driving directions. Claims and Billing Filing claims is fast and easy for AmeriHealth Caritas Delaware providers. AmeriHealth Administrators 24 hours a day, 7 days a week: 1-800-634-5334: PEAR Portal: PEAR Support: 1-833-444-7327: Provider Resources: Provider Automated System: 1-800-275-2583; prompt 2 www.amerihealth.com/providerautomatedsystem: Provider Services Mon. 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